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That all-important "someone" could be a nurse lobbyist, or nurses who have contacted their legislators. "When we go up on the Hill and talk to legislators, it helps us [the ANA] a lot when the legislators say we've heard from the nurses," Gonzalez said, because legislators are entrusted to respect the wishes of their constituents.

To encourage nurses to participate in the legislative process, Gonzalez said that the ANA keeps its Web site up to date with federal bill information. The state associations also track pending legislation on their sites.

For ANA members who would like to be even more involved, they can join N-STAT (Nurses Strategic Action Team) and receive weekly in-depth reports for the purpose of contacting legislators.

Building bridges

Although educating legislators and nurses is a major part of the lobbyist's job, it's also about "relationships and information," said Lydia Bourne, MA, RN, legislative advocate for the ANA\ C. "Strong relationships with the legislators, their staff and other lobbyists are really the key," she said. "This is how you share information, this is how you stay on top of things."

Gaining and sharing information provide muscle to the work of a lobbyist. To stay up to date, lobbyists have to keep their ear to the ground and "watch, look and listen," said Nancy Sharp, MSN, RN, legislative consultant for the American Nephrology Nurses'Association.

Sharp said some days she feels a little like Columbo, the TV detective from the '70s. "He'd be asking a witness questions, then get to the door and come back and say, now, what about this, what about that ... He had a nice way about trying to get more information."

In politics, information equals power. "You've got to get your network going," Sharp said. In her job, colleagues are expected to call colleagues and say, "Hey, I was on the Hill today, did you hear about …?"

Sharp said that as a lobbyist, "You're just moving and jiving and going around and keeping up."

In her "lobbying shop" at the ANA, Gonzalez said she and her staff have C-SPAN, cable television where they can view the proceedings of the day. "If we can't be on the Hill, we can monitor what's happening," she said.

One day while Gonzalez and her staff were working at the office writing letters of support, the ANA was misquoted by a legislator on the House floor. "We heard it," Gonzales said, "so we faxed something to someone else who was going to speak."

When the next legislator got up, he corrected the error and said, "This is what the ANA believes. I have a letter right here in my hand."

Gonzalez emphasizes that such quick turnaround of information rarely happens, but it resulted in plenty of high-fives among the staff.

In Washington, lobbyists frequently work in coalitions to move legislation. Sharp said when she visits legislators "on the Hill," most will ask who else is for or against a piece of legislation. "If you say these 30 or 40 organizations have signed on, they're relieved. It saves them time rather than hearing from each individual group."

Gonzalez said that the federal level, compared to the state level, can be more challenging because there are many more stakeholders, making the work more complex.

At the state level, some of the work is done in coalitions, but not as often. "It's friendlier," Sharp said. "When you [lobby in] Washington, you have to have an appointment and then it's usually with the health staff for that legislator. Lots of other people are calling, too."

Sharp said when she wants to speak to her own state legislator in Maryland, she can sometimes just knock on the door and go in. "It's more casual," she said.

When lobbyists aren't speaking with legislators or networking, they often are busy with giving testimony or arranging testimony for hearings. Both on the federal and state level, hearings occur when a proposed bill is passing through legislative committees. Hearings also can be used to gather in-depth information about an issue.

For hearings, "you think about who you want as your witnesses," Sharp said. "Sometimes, you write the verbal testimony for your witness" because in a bill hearing they have only two minutes to speak. "They have to talk succinctly, everything moves really fast."

The testimony has to build to make critical points and each new witness needs to say something that hasn't been said, Bourne said.